The Introduction of Generic Aromatase Inhibitors and Treatment Adherence Among Medicare D Enrollees

Neuner, Joan; Kamaraju, Sailaja; Charlson, John A.; Wozniak, Erica; Smith, Elizabeth C.; Biggers, Alana; Smallwood, Alicia; Laud, Purushottam W.; Pezzin, Liliana E.

doi:10.1093/jnci/djv130

Cited by 46 publications

(49 citation statements)

References 35 publications

(49 reference statements)

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“…Specifically, recent work by Neuner and Biggers documented a positive effect of drug copay assistance receipt on breast cancer patients’ adherence to aromatase inhibitors. [35,25] In contrast, we observed a negative effect of drug copay assistance receipt on aprepitant use. One possible explanation for this difference may be our measure of drug copay assistance receipt, which combined assistance through Medicaid dual eligibility and the Part D low-income subsidy (i.e., a woman was said to be a drug copay assistance recipient if she received either type of assistance), whereas Neuner’s and Biggers’ studies measured only Part D low-subsidy receipt.…”

Section: Discussioncontrasting

confidence: 72%

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

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Reeder‐Hayes

Basch

et al. 2016

Breast Cancer Res Treat

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Purpose Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. Methods We used 2006–2012 SEER-Medicare data to evaluate the use of neuroknin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results The study included 1,130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95% CI: 0.51–0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95% CI: 0.35–0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions We found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.

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Section: Discussioncontrasting

confidence: 72%

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

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Reeder‐Hayes

Basch

et al. 2016

Breast Cancer Res Treat

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“…The follow-up period for the post-Part D sample ended in 2012, shortly after the introduction of generic aromatase inhibitors. Future studies of even more recent cohorts may determine whether Part D has had a differential impact on reducing socioeconomic disparities in survival among breast cancer patients after introduction of generic aromatase inhibitors, which reduced out-of-pocket cost to patients by a much greater extent than the Part D program itself 10,18…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D

et al. 2017

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Background Breast cancer patients exhibit survival disparities based on socioeconomic status (SES). Disparities may be attributable to access to expensive oral endocrine agents. Objectives Define recent socioeconomic disparities in breast cancer survival and determine whether these improved after implementation of the Medicare Part D program. Design Difference-in-difference natural experiment of women diagnosed and treated before or after implementation of Medicare Part D. Subjects Female Medicare beneficiaries with early stage breast cancer: 54,772 diagnosed in 2001 and 46,371 in 2007. Measures SES was based on Medicaid enrollment and zip code per capita income, all-cause mortality from Medicare, and cause of death from National Death Index. Results Among women diagnosed pre-Part D, 40.5% of poor beneficiaries had died within 5 years compared to 20.3% of high-income women (p<0.0001). Post-Part D, 33.6% of poor women and 18.4% of high-income women died by 5 years. After adjustment for potential confounders, improvement in all-cause mortality post-Part D was greater for poorer women compared to more affluent women (p=0.002). However, absolute improvement in breast cancer-specific mortality was 1.8%, 1.2%, and 0.8% (p=0.88 for difference in improvement by SES) respectively for poor, near poor, and high-income women, while analogous improvement in mortality from other causes was 5.1%, 3.8% and 0.9% (p=0.067 for difference in improvement by SES). Conclusions Large survival disparities by SES exist among breast cancer patients. The Part D program successfully ameliorated SES disparities in all-cause mortality. However, improvement was concentrated in causes of death other than breast cancer, suggesting remaining gaps in care.

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“…3-5 However, most prior work examining medication adherence among patients with cancer has examined use of relatively affordable treatments, such as endocrine therapy, 6 or use among privately insured individuals with relatively generous prescription drug coverage. [7][8][9] Furthermore, because of the limitations of available data, most population-based studies of medication adherence have evaluated use among patients who had initiated therapy and have not considered factors associated with never starting therapy.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

Winn

Keating

Dusetzina

2016

JCO

106

111

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There is substantial concern surrounding affordability of orally administered anticancer therapies, particularly for Medicare beneficiaries. We examined rates of initiation and adherence to tyrosine kinase inhibitors (TKIs) among Medicare beneficiaries with chronic myeloid leukemia (CML) with and without cost-sharing subsidies. We selected TKIs given their effectiveness and strong indication for use among patients diagnosed with CML. Patients and MethodsUsing SEER-Medicare data, we identified individuals diagnosed with CML from 2007 to 2011. We used Cox proportional hazards regression to assess time from diagnosis to TKI initiation. We used generalized estimating equations to examine treatment initiation within 180 days and TKI adherence among initiators. We defined adherence as at least 80% of days covered during the 6 months after TKI initiation. Results Among 393 individuals diagnosed with CML from 2007 to 2011, 68% initiated TKI treatment within 180 days after diagnosis. In multivariate analysis, individuals with cost-sharing subsidies, younger age, lower comorbidity, and later year of diagnosis were significantly more likely to initiate TKIs. Among TKI initiators, 61% were adherent; adherence was lower for individuals age 80 years or older versus 66 to 69 years. ConclusionOnly 68% of Medicare beneficiaries with CML initiated TKI therapy within 6 months of diagnosis. Delayed initiation among individuals without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy among individuals diagnosed with CML.

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The Introduction of Generic Aromatase Inhibitors and Treatment Adherence Among Medicare D Enrollees

Abstract: The introduction of generic medications attenuated the decline in adherence to AIs over three years of treatment among breast cancer survivors not receiving low-income subsidies for Medicare D coverage.

Cited by 46 publications

References 35 publications

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

Socioeconomic Disparities in Mortality Among Women With Incident Breast Cancer Before and After Implementation of Medicare Part D

Factors Associated With Tyrosine Kinase Inhibitor Initiation and Adherence Among Medicare Beneficiaries With Chronic Myeloid Leukemia

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